title: Prevalence and predictors of elevated aspartate aminotransferase-to-platelet ratio index in Latin American perinatally HIV-infected children.
abstract: BACKGROUND
  Chronic liver disease has emerged as an important problem in adults with longstanding HIV infection, but data are lacking for children. We characterized elevated aspartate aminotransferase-to-platelet ratio index (APRI), a marker of possible liver fibrosis, in perinatally HIV-infected children.
  
  
  METHODS
  The National Institute of Child Health and Human Development International Site Development Initiative enrolled HIV-infected children (ages 0.1-20.1 years) from 5 Latin American countries in an observational cohort from 2002 to 2009. Twice yearly visits included medical history, physical examination and laboratory evaluations. The prevalence (95% confidence interval) of APRI > 1.5 was calculated, and associations with demographic, HIV-related and liver-related variables were investigated in bivariate analyses.
  
  
  RESULTS
  APRI was available for 1012 of 1032 children. APRI was >1.5 in 32 (3.2%, 95% confidence interval: 2.2%-4.4%) including 2 of 4 participants with hepatitis B virus infection. Factors significantly associated with APRI > 1.5 (P < 0.01 compared with APRI ≤ 1.5) included country, younger age, past or current hepatitis B virus, higher alanine aminotransferase, lower total cholesterol, higher log10 current viral load, lower current CD4 count, lower nadir CD4 count, use of hepatotoxic nonantiretroviral (ARV) medications and no prior ARV use. Rates of APRI > 1.5 varied significantly by current ARV regimen (P = 0.0002), from 8.0% for no ARV to 3.2% for non-protease inhibitor regimens to 1.5% for protease inhibitor-based regimens.
  
  
  CONCLUSIONS
  Elevated APRI occurred in approximately 3% of perinatally HIV-infected children. Protease inhibitor-based ARVs appeared protective whereas inadequate HIV control appeared to increase risk of elevated APRI. Additional investigations are needed to better assess potential subclinical, chronic liver disease in HIV-infected children.
authors.affiliation: From the *Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda; †Westat, Rockville, MD; ‡Department of Infectious Diseases, Hospital Federal dos Servidores do Estado; §Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro; ¶Vertical Transmission Unit, Femina Hospital, Porto Alegre; ‖Department of Pediatrics, University of São Paulo Faculty of Medicine of Ribeirão Preto, Ribeirão Preto; and **Department of Pediatrics, Federal University of Minas Gerais, Belo Horizonte, Brazil.
authors.forename: George K
authors.initials: GK
authors.lastname: Siberry
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Cohen
authors.forename: D Robert
authors.initials: DR
authors.lastname: Harris
authors.forename: Maria Leticia Santos
authors.initials: ML
authors.lastname: Cruz
authors.forename: Ricardo
authors.initials: R
authors.lastname: Oliveira
authors.forename: Mario F
authors.initials: MF
authors.lastname: Peixoto
authors.forename: Maria Celia
authors.initials: MC
authors.lastname: Cervi
authors.forename: Rohan
authors.initials: R
authors.lastname: Hazra
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Pinto
mesh_terms: D001219:Aspartate Aminotransferases / Q000097:blood*; D001792:Blood Platelets / Q000166:cytology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000097:blood* / Q000201:enzymology* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D018445:Infectious Disease Transmission, Vertical; D007843:Latin America / Q000453:epidemiology; D008103:Liver Cirrhosis / Q000097:blood / Q000201:enzymology / Q000821:virology; D008297:Male; D010976:Platelet Count; D015995:Prevalence; D012680:Sensitivity and Specificity
chemical_list: D001219:Aspartate Aminotransferases